US Supports Worldwide Offensive Against AIDS

Small businesses in Zaire, recruited to help distribute condoms, ring up 15-fold increase in use over two years; AIDS rate levels off

REELING from the scourge of AIDS, the epidemic that is cutting a wide swath of trouble through sub-Saharan Africa, Zaire recently launched an innovative counteroffensive.Using a United States-funded program of "social marketing," government officials turned over the job of distributing condoms - one of the main weapons in the war against AIDS - to an army of small entrepreneurs. Armed with a profit motive and "selling condoms like Coca-Colas," in the words of one American official, they created a 15-fold increase in demand in just two years. One result: the country's high rate of AIDS has leveled off. Zaire's experiment in social marketing is one of the notable success stories written by governments and private groups that have hastily thrown up barricades against the encroaching epidemic. But prevention efforts have been too little, too late, and too diffuse to keep pace, according to experts who met in Washington recently to discuss prevention strategies. "The situation is bad and getting worse, both in terms of the spread of the virus and the impact AIDS is having on the third world," says Jeffrey Harris, coordinator of AIDS programs for the US Agency for International Development (USAID), which sponsored the confernece. "AIDS has become a global plague; it's a modern black death," adds Sen. Patrick Leahy (D) of Vermont, chairman of a Senate subcommittee that this year voted to recommend appropriation of $65 million to fund the agency's anti-AIDS programs.

Africa hardest hit The AIDS epidemic is worst in Africa, home to nearly half the estimated 8 million carriers of the HIV virus that causes AIDS. But its fastest growth now is in Asia, where it was practically unknown as recently as three years ago. In Thailand, where only 50 AIDS cases were reported by mid-1990, 15 percent of all Army recruits now test positive for the AIDS virus. The AIDS epidemic is also spreading rapidly throughout Central and Latin America. Though now reaching into rural areas, AIDS has had its greatest impact on urban populations. In some African cities like Lusaka, in Zambia, and Kampala, in Uganda, AIDS has afflicted more than a quarter of the population, as compared with 1 percent in the US. In several African cities it has become the leading cause of adult death. In all, some 10 million people are now infected with the HIV virus, according to estimates by the World Health Organization (WHO). Within a decade the number could quadruple to 40 million, including 10 million infants and children, according to WHO. In the third world, which accounts for two-thirds of the world's AIDS cases, the consequences of the AIDS epidemic have been especially severe. It has reduced productivity, washed away the meager economic gains of recent years, and is now on the verge of overwhelming health-care facilities. In Uganda alone, 7 percent of the population under 15 was orphaned by 1990 because of the epidemic. In this largely rural society, typical of central Africa, the high casualty rate among working-age adults has disrupted agriculture, threatening increased malnutrition and forcing villages to abandon labor-intensive export crops like coffee, which are a crucial source of foreign exchange. Faced with the sudden crisis, private groups and international donors like WHO and USAID have rallied to find ways to stem the spread of the virus for which no medical cure now exists. The biggest success has been in AIDS education. Long considered taboo subjects, AIDS and the sexual practices that have resulted in 75 percent of AIDS cases in the third world are now the focus of intensive public information campaigns disseminated through schools and churches, governments and the media. "There's been a major-league change in knowledge," says Dr. Harris. "Ninety percent of people worldwide now know what AIDS is and what the major transmission routes are."

Reducing risk Beyond information is the harder matter of actually reducing high-risk sexual practices. USAID officials say that celibacy and monogamy constitute the most effective line of defense. But, they say, AIDS prevention also means finding ways to encourage the use of condoms and the limiting of sexual partners and to diagnose and treat sexually transmitted diseases. The most successful programs have harnessed nonprofessionals, like a bartender at a truck stop in Tanzania who now includes a free condom with drinks sold to a high-risk clientele of truck drivers and prostitutes. USAID officials acknowledge that there are no data to confirm that the frequency of sexual contacts has diminished as a result of AIDS education campaigns in third-world countries. But they point to heartening anecdotal evidence that vulnerable groups are starting to use more caution in selecting partners. Also heartening has been a fivefold increase in USAID condom shipments to Africa since 1987 in response to demand generated by increasing awareness of the existence and causes of AIDS. "Fidelity is best, but if you stray, use a safety net," proclaims a successful advertising pitch in one Caribbean country that features a picture of high-flying trapeze artists. Condom use in several African countries has leaped from 15 to 50 percent since AIDS information campaigns were first put in place less than five years ago. But USAID officials caution that the increase will barely make a dent in the problem. "Even at the higher levels there are enough for only 1 or 2 percent of the total number of men in Africa," says Harris. "So let's not kid ourselves. No one thinks that's even close to making a difference."

$400 million budgeted The largest financial supporter of AIDS programs in the world, USAID plans to spend nearly $400 million on prevention projects over the next five years, much of it in 15 targeted countries. It's a start, agency officials say, but hardly enough to stem the threat of social and economic disruption posed by AIDS in the third world.

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